Post on 29-Dec-2015
transcript
Massachusetts Maternal, Infant, and Early Childhood Home
Visiting Initiative
Indicator Selection and Community Scoring Methodology
Needs Assessment: Indicator Selection Process
Task Force
Work Group
Research Team
Broad brainstormingsession on potentialindicators related to
infant, child, and maternal health
Research suggested
indicators and determine
availability at state or
community level
Does indicator add unique value?
Does indicator align with MA
priorities?
Yes No
Indicator added to
community rankings
Indicator included in statewide
profile
Phase 1: Brainstorming
Phase 2:Model Selection
of Indicators Available at Community
Level
Needs Assessment: Indicator Research Obstacles and Approaches
• Obstacle: Small numbers and suppression of data– Ex. MassCHIP, MA’s online data resource for many of the HV
indicators, suppresses cell information <5 for confidentiality
• MA Approach: – Aggregated five years to have stable data (ex. IMR)– In cases where communities had no data, statewide averages were
used in rankings to minimize both over- and under-estimating risk – When data were missing in >50% of cells, indicator excluded from
analysis and only used in statewide profile (ex. Childhood BMI)
• Obstacle: Not all MA data aligned with city/towns– Ex. MA school districts overlap
• MA Approach: – Mapped one indicator to multiple communities
Needs Assessment Example: MA Indicator Selection Process for
Domain 1:# Outcome Domain Data Indicators
(bold=required / highlighted=included in community ranking)
City/Town
Statewide
1 Improvements in Maternal and Infant Health
% premature (<37 wks) by gestational age X
% low birth weight X
Infant mortality rate per 1,000 X
% less than adequate prenatal care X
% of mothers not intending to breastfeed X
Maternal overweight and obesity X
Rate of women smoking during pregnancy X
Substance abuse in pregnancy X
Alcohol use in pregnancy X
Maternal deaths per 100,000 live births X
Pregnancy-associated deaths per 100,000 live births
X
Inter-pregnancy intervals (IPI) X
Maternal Depression/Family Mental Health X
# of mental health visits to ER’s for women aged 15-44 years
X
# of mental health visits to ER’s for men aged 15-44 years
X
Needs Assessment: MA Indicator Selection for Community Ranking Across Domains
Domain (# Indicators) Indicators (Bold=required)
Maternal and Infant Health (6) Premature birth; Low-birthweight; IMR; prenatal care; breastfeeding; maternal smoking
Child health and development (2) Asthma; Lead poisoning
Child school readiness (4) EI enrollment; HS dropout rate; Poor performing schools; Waitlist for subsidized child care
Child injuries and maltreatment (2) Unintentional injuries; Composite maltreatment score
Parenting skills (4) Teen birth rate; Mothers <HS edu; Single parent households; Substance abuse
Crime or domestic violence (1) Violent crime*
Family economic self-sufficiency (3) Unemployment; < 100% poverty; Women giving birth on public assistance
Coordination of referrals for other community resources and supports (0)
Vulnerable population (4) ESL; Limited English proficiency; non-white population; Foreign-born mothers
*Note: Although required, there was no MA domestic violence indicator available at community level.
6
Needs Assessment: Indicator Ranking and Community Scoring Process
Step 1: If indicator is not available at city/town level, substitute statewide value for city/town
Step 2: Sort (in ascending order) cities/towns using 1 indicator at a time as the primary sort key
Step 3: Calculate Range: Subtract city/town with highest value in given indicator from city/town with lowest value
Step 4:
Take the magnitude of the range and divide it into 100 equal intervals in order to obtain grouped data for each indicator (this determines the category increments based on 100 categories)
Step 5:
The cities/towns that fell into the lowest category are assigned a rank value of 1; those that fell into the highest category are assigned a rank value of 100; the rest are ranked accordingly based on their positions in respective categories
Step 6: Final community ranking is based on composite score of each community (add individual rank values across all indicators)
Source: Health Status Need Ranking of Massachusetts Communities: A Methodology for Needs Assessment by Marlene Anderka and Ahmad Sharbatoglie
Needs Assessment Example: Holyoke, MA
Indicator Holyoke Standardized Score(1-100)
Risk Assessment
% Premature birth(<37 wks gestation)
8.22% 78 Low Risk
% Low-birth weight infants (<2500g)
9.3% 52 Average Risk
Infant mortality rate(deaths/1,000 live births)
8.93/1,000 13 Very High Risk
% Less than adequate prenatal care (Kotelchuck index)
23.4% 71 Low Risk
% Mothers not intending to breastfeed
30.6% 61 Low Risk
% Maternal smoking during pregnancy
8.32% 78 Low Risk
Sum: 353
Needs Assessment: Composite score for each community
Example: Holyoke, MADomain (# Indicators) Sum of Indicator Standardized Scores
Maternal and Infant Health (6) 353
Child health and development (2) 141
Child school readiness (4) 98
Child injuries and maltreatment (2) 90
Parenting skills (4) 63
Crime or domestic violence (1) 35
Family economic self-sufficiency (3) 39
Vulnerable population (4) 204
COMPOSITE SCORE 1023
Needs Assessment: Community Ranking Identifying High Need Communities in
Massachusetts• Lowest Composite Score: 1023• Highest Composite Score: 2394
• Range: 1371• Distribution: 274.2
Lower Bound
Upper Bound # Cities
Group 1 1023 1297.2 8
Group 2 1297.2 1571.4 9
Group 3 1571.4 1845.6 29
Group 4 1845.6 2119.8 145
Group 5 2119.8 2394 160
351
High Need Communities
1 2 3 4 5
160145
29
9 80
50
100
150
200
# ofCommunities
Composite Need Score Groups
Needs Assessment: Composite Need Score for All 351 MA Cities/Towns
Lowest Need/Highest Score
Highest Need/
Lowest Score
1. Holyoke2. Lawrenc
e3. Springfie
ld4. Chelsea5. Lowell6. New
Bedford7. Fall
River8. Lynn
1. Holyoke2. Lawrenc
e3. Springfie
ld4. Chelsea5. Lowell6. New
Bedford7. Fall
River8. Lynn
10
9. Southbridge
10. Boston11. Brockton12. Worcester13. Revere14. Pittsfield15. N. Adams16. Everett17. Fitchburg
9. Southbridge
10. Boston11. Brockton12. Worcester13. Revere14. Pittsfield15. N. Adams16. Everett17. Fitchburg
Needs Assessment: Highest Need Communities as Determined by Needs
Assessment